176 Renal failure after CRT implantation: more than a contrast nephropathy

Abstract

We studied short term effect of CRT implantation on renal function and focused especially on the role of contrast agent dose. : Acute renal failure (ARF) was defined as a decrease of more than 25% of the clearance of creatinine (Cl Cr) calculated with MDRD method within four days following implantation. : We considered 141 patients referred for CRT implantation: male: 79%, mean age: 68 +/−12, diabetes: 71%, HTA: 38%, Cl Cr: 48 mL +/−19, median contrast dose: 48 mL (IR: 30/80), median BNP variation: −30% (IR:-58/-8), Haemoglobin (Hb) variation: −6.3% +/−11.2. ARF occurred in 19 patients (13.5%), 3 of them died and one was lost. Renal function of 14 out of the 15 remaining completely recovered. In-hospital stay longer than 10 days was more frequent in ARF group (OR = 5.18, p<0.03). Decrease of Hb was the only independent factor of ARF with a negative correlation (OR = 0.94, p < 0.01). Treatment with ACEI (OR = 6.13, p = 0.09) and HTA (OR = 2.62, p = 0.06) tend to be positively associated with ARF while a contrast dose above 80 mL tends to be negatively associated (OR = 0.24, p = 0.08). High dose of contrast administration was associated with low Cl Cr (spearman correlation coefficient = −0.19, p < 0.03) and decrease of Hb (−1.21, p < 0.02). : Acute renal failure is a frequent and severe complication after CRT implantation. Careful pre and post implantation management is required. Mechanism seems more complex than a contrast induced nephropathy.